Effectiveness of individualised intervention on pulmonary function in women with post-mastectomy syndrome

Abstract

PURPOSE:

This study aimed to investigate the effects on the pulmonary function in women with post-mastectomy syndrome during different 48-week individualised physical rehabilitation programs.

METHODS:

The participants of this study were 115 breast cancer patients with late symptoms of post-mastectomy syndrome who completed intervention and 50 healthy women (control group). Women had undergone surgical treatment and adjuvant radiation therapy for breast cancer. Women with post-mastectomy syndrome were enrolled for the first individualised program (first main group, MG₁, n = 45), for the second individualised program (second main group, MG₂, n = 40) and for the third individualised program (third main group, MG₃, n = 30). The first program included aqua aerobics (aqua jogging, aqua building, aqua stretching), conditional swimming, and recreational aerobics; the second program included conditional swimming and Pilates exercises; the third program included yoga-based exercises and stretching.

RESULTS:

It was found that most of the spirometry parameters steadily improved in all groups during a 48-week individualised physical rehabilitation programs. After that period of training the individualised program for women of the first main group came to have an advantageous effect on all the indicators of respiratory function (p < 0.05– p < 0.001) as compared with the healthy women, except for the expiratory reserve volume, and maximal voluntary ventilation, which were not statistically significant.

CONCLUSIONS:

Our findings showed that individualized physical rehabilitation programs had a positive effect on pulmonary function in women with post-mastectomy of all groups.

Keywords

Pulmonary function rehabilitation breast cancer mastectomy

1 Introduction

The growing literature indicates that breast cancer survivors have considerable treatment-related side effects [1 –3]. A number of published studies have shown that affected women may have a lot of negative emotions, frustration, impairment in shoulder joint motion, lymphedema, decrease of neurohumoral regulation, cardiopulmonary toxicity, brachial nerve palsy, radiological changes, and alterations in pulmonary function caused by surgical and radiation therapies [4 –8].

Some papers have presented that breast cancer survivors often experience activity-related dyspnea, respiratory muscle weakness, deconditioning, exercise intolerance, and impaired lung diffusion [8 –11]. According to recent studies [12 –17], doing physical exercises is a key factor in improving muscular strength, endurance, cardiopulmonary function, and overcoming negative treatment-related side effects.

At the same time, it is emphasized that rehabilitation program should be individualised for all breast cancer patients according to their preferences, and physical activity level. Only several studies [12 , 17] have shown the importance of individualized exercise for the of improvement cardiopulmonary parameters, fatigue reduction, and quality of life in breast cancer survivors.

All the above mentioned the importance of developing individualised physical rehabilitation programs alongside with the need to determine their benefit for the respiratory system in patients with post-mastectomy syndrome.

The purpose of this study was to investigate the effects on the pulmonary function in women with post-mastectomy syndrome during a 48-week different individualised physical rehabilitation programs.

The primary outcome was to compare pulmonary function at 48 weeks within group changes. Furthermore, secondary outcomes were to compare pulmonary function at 48 weeks between group changes.

2 Methods

The research was performed at the Khortytsia National Academy (Ukraine). The study was conducted in accordance with ethical principles stated in the Declaration of Helsinki and approved by Ethical Committee of Khortytsia National Academy.

The study was designed as a randomized, prospective, controlled trial in accordance with the CONSORT guidelines. CONSORT flow diagram is presented at Fig. 1. 124 women with post-mastectomy syndrome were randomly enrolled for the first individualised program (first main group, MG₁, n = 50), for the second individualised program (second main group, MG₂, n = 44) and for the third individualised program (third main group, MG₃, n = 30). Women had undergone surgical treatment and adjuvant radiation therapy for breast cancer. The average age of patients with post-mastectomy syndrome was 59.49±1.06 years. The time after surgery was 6,12±0,27 months. The control group (CG) consisted of 50 healthy women. The average age of control group patients was 59,92±0,77 years.

Fig.1

Consort flow diagram.

The inclusion criteria were as follows: 50–60 years of age, recent history of modified radical mastectomy, normal body mass index, consent to participate in the study, breast cancer-related lymphedema, limitation of shoulder joint motion, and decreased muscle strength of the hand on the side of the surgery. The exclusion criteria were as follows: bilateral lymphedema, metastasis, body mass index exceeding 25 kg/m², primary lymphedema, pulmonary edema, chronic nonspecific lung disease, congestive heart failure, or any contraindications limiting activity. All the women who were selected for the research met the eligibility criteria.

Written informed consent was obtained from all the participants before randomization. Patients were randomized into one of three groups (MG₁, MG₂, and MG₃) using sequentially numbered, opaque sealed envelopes. Medical information concerning the stage of disease, surgery, and adjuvant therapy was obtained from medical records.

The first individualised physical rehabilitation program included aqua aerobics (aqua jogging, aqua building, aqua stretching), conditional swimming, and recreational aerobics; the second program included conditional swimming and Pilates exercises; the third program included yoga-based exercises and stretching. The intervention groups attended appropriate individualised physical rehabilitation programs 3 times per week for 48 weeks conducted by the same physiotherapist.

Aqua aerobics and conditional swimming were carried out in the pool with water temperature about 28–30°C. Aqua aerobics was performed at the optimum depth of the pool, that of 120–130 cm, which allowed patients to submerge in water almost all parts of the body and to load all muscle groups. The structure of aqua aerobics consisted of aqua jogging exercises (20%), aqua building (50%), and aqua stretching (30%). Special equipment was used, like noodles, aqua dumb-bells etc. for performing strength exercises. Exercises like underwater breathing and flotation were carried out to improve the functional state of respiratory system and to reduce water-repellency, as well as to ensure that it was comfortable for the participants move around the pool. Differentiated approach to low-impact and middle-impact aerobic exercises was provided in accord with the participants’ health status. Exercise intensity for women ranged from 40% to 60% of heart rate reserve.

The exercise intensity and session length depended on the level of the functional state of cardiovascular system, which was determined by the author’s formula [18]. The developed method for determining the level of the functional state of the cardiovascular system of women with post-mastectomy syndrome included age and objectively defined parameters of central hemodynamics: heart rate, cardiac output and left ventricle work.

The second individualised physical rehabilitation program included conditional swimming and Pilates exercises practiced three times a week. The level of women’s physical condition, the number of laps, power zone, the number of repetitions and exercise intensity, rest interval during planning for conditional swimming were taken into consideration. The load intensity was selected individually for each patient.

The structure of Pilates classes consisted of Pilates matwork exercises (50%), Power Pilates (20%), Pilates ball (20%), and Pilates stretch (10%). Exercise intensity for women ranged from 40%–60% of heart rate reserve depending on the participants’ health status. Each exercise session was individualized for the women with post-mastectomy syndrome but generally included a 10-minute warm-up, 40 minutes of aerobic exercise, resistance training and stretching, and was concluded with a 10-minute cool-down. Resistance and flexibility training consisted of exercises subjected to all of the major muscle groups. The training sessions were concluded with a low-intensity (<40% HRR) cool-down exercises targeted at all major muscle groups.

The third individualised physical rehabilitation program included yoga-based exercises (60%) and stretching (40%). Before performing asanas and breathing exercises, all women regardless of the level of functional state of cardiovascular system performed articular gymnastics, which involved preparing the body for the main load and contributing to an increase in the amplitude of movements in the joints, particularly in the shoulder. Particular attention was given to poses that emphasized upper body strength and flexibility, while avoiding significant time with the upper extremity in a dependent position.

Functional state of the external respiration system was assessed by spirometry. It was recorded at baseline, six, and twelve months after performing individualized physical rehabilitation programs. Spirometry was carried out with the help of SMP-21/01 RD Spirometer SMP-21/01 RD (Monitor Ltd. Co., Rostov-on-Don, Russia). Before performing spirometry, the equipment was calibrated and standard spirometry instruction was given to patients. Examined women were tested in the seated and relaxed position wearing a nose clip with no air leaks between the mouth and the mouthpiece. Evaluation of pulmonary function was performed by a pulmonologist. Assessor of pulmonary function tests was blinded to the group allocation.

Obtained results were given in both raw data (litres, litres per second) and percent predicted according to height, age, sex, and weight. Multiple maneuvers (Vital capacity, Forced vital capacity, Maximal voluntary ventilation) were obtained from each patient, and the spirometry values associated with the best maneuver were input into database.

The following indicators were assessed: Vital capacity (VC) litres, Forced vital capacity (FVC) litres, Forced expiratory volume in one second (FEV₁) litres, Peak expiratory flow (PEF) l/sec, Maximum expiratory flow at 25% of FVC (MEF₂₅) l/sec, Maximal expiratory flow at 50% FVC (MEF₅₀) l/sec, Maximal voluntary ventilation (MVV) l/min, Inspiratory reserve volume (IRV) litres, Expiratory reserve volume (ERV) litres.

Analysis of results were performed using Statistica for Windows (version 8.00) and by analyzing descriptive statistics (mean, and standard error of the mean). Before the statistical analysis, the Shapiro-Wilk test was used to test for normal distribution of data. Independent sample t-tests were used to compare respiratory parameters between the women of main groups and control group. Paired t-test of respiratory parameters was done after six and twelve months after performing individualized physical rehabilitation programs to check the change in spirometry indicators within the main groups. A p < 0.05 was considered statistically significant.

3 Results

The results of the analysis of respiratory function parameters within groups after participating in the 48-week individualised physical rehabilitation programs showed a positive impact on women of all groups. Changes in the spirometry parameters of the first main group are presented in Table 1.

Table 1
The evolution of spirometry parameters (M±m) in patients of the first main group (MG₁) during a 48-week individualised physical rehabilitation program

Indicator, units of measurement MG₁ (n = 45)

Beginning 48 weeks

Vital capacity, l Actual 2.41±0.04 2.95±0.04^*

% of predicted 77.60±1.37 95.86±1.58^*

Forced vital capacity, l Actual 2.34±0.04 2.81±0.03^*

% of predicted 79.91±1.40 96.62±1.38^*

Forced expiratory volume in 1 second, l Actual 2.01±0.05 2.62±0.02^*

% of predicted 82.77±2.39 109.75±1.77^*

Peak expiratory flow, l/sec Actual 3.40±0.16 4.82±0.13^*

% of predicted 58.68±2.81 83.88±2.21^*

Maximum expiratory flow₂₅, l/sec Actual 2.93±0.14 4.44±0.10^*

% of predicted 57.22±2.87 88.06±2.12^*

Maximum expiratory flow₅₀, l/sec Actual 3.01±0.14 3.97±0.07^*

% of predicted 84.26±3.78 113.75±2.72^*

Inspiratory reserve volume, l 1.10±0.04 1.56±0.06^*

Expiratory reserve volume, l 0.70±0.03 0.97±0.06^*

Maximal voluntary ventilation, l/min 58.87±3.14 86.38±3.00^***

Indicator, units of measurement	MG₁ (n = 45)
Vital capacity, l	Actual	2.41±0.04	2.95±0.04^***
	% of predicted	77.60±1.37	95.86±1.58^***
Forced vital capacity, l	Actual	2.34±0.04	2.81±0.03^***
	% of predicted	79.91±1.40	96.62±1.38^***
Forced expiratory volume in 1 second, l	Actual	2.01±0.05	2.62±0.02^***
	% of predicted	82.77±2.39	109.75±1.77^***
Peak expiratory flow, l/sec	Actual	3.40±0.16	4.82±0.13^***
	% of predicted	58.68±2.81	83.88±2.21^***
Maximum expiratory flow₂₅, l/sec	Actual	2.93±0.14	4.44±0.10^***
	% of predicted	57.22±2.87	88.06±2.12^***
Maximum expiratory flow₅₀, l/sec	Actual	3.01±0.14	3.97±0.07^***
	% of predicted	84.26±3.78	113.75±2.72^***
Inspiratory reserve volume, l	1.10±0.04	1.56±0.06^***
Expiratory reserve volume, l	0.70±0.03	0.97±0.06^***
Maximal voluntary ventilation, l/min	58.87±3.14	86.38±3.00^***

Notes: ^***p < 0.01 compared with the initial data; VC – Vital capacity, FVC – Forced vital capacity, FEV₁ – Forced expiratory volume in one second, PEF – Peak expiratory flow, MEF₂₅ – Maximum expiratory flow at 25% of FVC, MEF₅₀ – Maximal expiratory flow at 50% FVC, IRV – Inspiratory reserve volume, ERV – Expiratory reserve volume, MVV – Maximal voluntary ventilation.

Table 2

The evolution of spirometry parameters (M±m) in patients of the second main group (MG₂) during a 48-week individualised physical rehabilitation program

Indicator, units of measurement		MG₂ (n = 40)
		Beginning	48 weeks
Vital capacity, l	Actual	2.47±0.04	2.73±0.03^***
	% of predicted	79.60±1.91	88.30±1.60^**
Forced vital capacity, l	Actual	2.38±0.03	2.64±0.02^***
	% of predicted	80.85±1.56	90.50±1.42^***
Forced expiratory volume in 1 second, l	Actual	2.04±0.04	2.38±0.04^***
	% of predicted	84.35±2.14	98.67±2.17^***
Peak expiratory flow, l/sec	Actual	3.08±0.15	3.79±0.13^**
	% of predicted	53.15±2.75	65.72±2.30^**
Maximum expiratory flow₂₅, l/sec	Actual	2.83±0.12	3.51±0.12^**
	% of predicted	55.32±2.53	69.17±2.54^**
Maximum expiratory flow₅₀, l/sec	Actual	2.65±0.13	3.38±0.11^***
	% of predicted	74.55±3.99	95.60±3.22^***
Inspiratory reserve volume, l		1.14±0.04	1.15±0.07
Expiratory reserve volume, l		0.69±0.06	1.01±0.10^*
Maximal voluntary ventilation, l/min		58.48±2.13	68.46±1.96^**

Notes: ^*p < 0.05, ^**p < 0.01, ^***p < 0.01 compared with the initial data; VC – Vital capacity, FVC – Forced vital capacity, FEV₁ – Forced expiratory volume in one second, PEF – Peak expiratory flow, MEF₂₅ – Maximum expiratory flow at 25% of FVC, MEF₅₀ – Maximal expiratory flow at 50% FVC, IRV – Inspiratory reserve volume, ERV – Expiratory reserve volume, MVV – Maximal voluntary ventilation.

The results presented in Table 1 show that most indicators of lung function improved significantly after 48 weeks of training, particularly those of the actual Vital capacity, which improved by 0.54 l (p < 0.001); Forced vital capacity, which improved by 0.47 l (p < 0.001); Forced expiratory volume in 1 second, which improved by 0.61 l (p < 0.001); Peak expiratory flow, which improved by 1.42 l/sec (p < 0.001); Maximum expiratory flow₂₅, which improved by 1.51 l/sec (p < 0.001); Maximum expiratory flow₅₀, which improved by 0.96 l/sec (p < 0.001); Inspiratory reserve volume, which improved by 0.46 l (p < 0.001); Expiratory reserve volume, which improved by 0.27 l (p < 0.001); Maximal voluntary ventilation, which improved by 27.51 l/min (p < 0.001); and the relative values of VC, FVC, FEV₁, PEF, MEF₂₅, and MEF₅₀, which improved by 18.26 (p < 0.001), 16.71 (p < 0.001), 26.98 (p < 0.001), 25.20 (p < 0.001), 30.84 (p < 0.001), and 29.49% (p < 0.001), respectively.

Changes in the spirometry parameters of the second main group are presented in Table 2. As it can be seen from the Table 2, during 48 weeks of rehabilitation by the second individualised program it was shown that women significantly improved the actual Vital capacity, which improved by 0.26 l (p < 0.001); Forced vital capacity, which improved by 0.26 l (p < 0.001); Forced expiratory volume in 1 second, which improved by 0.34 l (p < 0.001); Maximum expiratory flow₂₅, which improved by 0.68 l/sec (p < 0.01); Maximum expiratory flow₅₀, which improved by 0.73 l (p < 0.001). During the year of training, the relative values of VC increased significantly by 8.70% (p < 0.01), FVC increased by 9.65% (p < 0.001), MEF₂₅ increased by 13.85% (p < 0.01), MEF₅₀ increased by 21.05% (p < 0.001).

Changes in the spirometry parameters of the third main group are presented in Table 3. A similar tendency of improvement of the respiratory parameters was also observed in the third main group, in which indicators of VC, FVC, FEV, PEF, MEF₂₅, MEF₅₀ and MVV increased by 500 ml (p < 0.001), 340 ml (p < 0.001), 0.39 l (p < 0.001), 0.79 l/sec (p < 0.001), 0.67 l/sec (p < 0.001), 0.93 l/sec (p < 0.001), and 25.80 l/min (p < 0.001), respectively. The relative values of the above parameters also significantly increased during the year.

Table 3

The evolution of spirometry parameters (M±m) in patients of the third main group (MG₃) during a 48-week individualised physical rehabilitation program

Indicator, units of measurement		MG₃ (n = 30)
		Beginning	48 weeks
Vital capacity, l	Actual	2.47±0.04	2.97±0.05^***
	% of predicted	77.76±1.58	94.50±2.04^***
Forced vital capacity, l	Actual	2.36±0.04	2.70±0.04^***
	% of predicted	78.90±1.71	91.16±1.41^***
Forced expiratory volume in 1 second, l	Actual	2.04±0.04	2.43±0.04^***
	% of predicted	82.90±1.98	99.40±1.82^***
Peak expiratory flow, l/sec	Actual	3.16±0.15	3.95±0.08^***
	% of predicted	54.50±2.63	67.86±1.49^***
Maximum expiratory flow₂₅, l/sec	Actual	2.89±0.13	3.56±0.07^***
	% of predicted	55.73±2.73	69.56±1.66^***
Maximum expiratory flow₅₀, l/sec	Actual	2.77±0.12	3.70±0.07^***
	% of predicted	77.03±3.58	103.70±2.52^***
Inspiratory reserve volume, l		1.08±0.09	1.13±0.07
Expiratory reserve volume, l		0.72±0.09	1.02±0.10^*
Maximal voluntary ventilation, l/min		59.33±2.12	85.13±2.68^***

Table 4

Comparison of spirometry parameters (M±m) between the patients of the main groups during 48-week individualised physical rehabilitation programs

Indicator, units of measurement		48 weeks
		MG₁ (n = 45)	MG₂ (n = 40)	MG₃ (n = 30)
Vital capacity, l	Actual	2.95±0.04	2.73±0.03^***	2.97±0.05
	% of predicted	95.86±1.58	88.30±1.60^**	94.50±2.04
Forced vital capacity, l	Actual	2.81±0.03	2.64±0.02^***	2.70±0.04^•
	% of predicted	96.62±1.38	90.50±1.42^**	91.16±1.41^•
Forced expiratory volume in 1 second, l	Actual	2.62±0.02	2.38±0.04^***	2.43±0.04^•^•^•
	% of predicted	109.75±1.77	98.67±2.17^***	99.40±1.82^•^•^•
Peak expiratory flow, l/sec	Actual	4.82±0.13	3.79±0.13^***	3.95±0.08^•^•^•
	% of predicted	83.88±2.21	65.72±2.30^***	67.86±1.49^•^•^•
Maximum expiratory flow ₂₅, l/sec	Actual	4.44±0.10	3,51±0.12^***	3.56±0.07^•^•^•
	% of predicted	88.06±2.12	69.17±2.54^***	69.56±1.66^•^•^•
Maximum expiratory flow ₅₀, l/sec	Actual	3.97±0.07	3.38±0.11^***	3.70±0.07^•
	% of predicted	113.75±2.72	95.60±3.22^**	103.70±2.52^•^•
Inspiratory reserve volume, l		1.56±0.06	1.15±0.07^***	1.13±0.07^•^•^•
Expiratory reserve volume, l		0.97±0.06	1.01±0.10	1.02±0.10
Maximal voluntary ventilation, l/min		86.38±3.00	68.46±1.96^***	85.13±2.68

Notes: ^*p < 0.05, ^**p < 0.01,^**p < 0.001 compared with the data of the first main group and the second main group; ^•p < 0.05; ^•^•p < 0.01 ^•^•^•p < 0.001 compared with the data of the first main group and the third main group; VC – Vital capacity, FVC – Forced vital capacity, FEV₁ – Forced expiratory volume in one second, PEF – Peak expiratory flow, MEF₂₅ – Maximum expiratory flow at 25% of FVC, MEF₅₀ – Maximal expiratory flow at 50% FVC, IRV – Inspiratory reserve volume, ERV – Expiratory reserve volume, MVV – Maximal voluntary ventilation.

Table 5

Comparison of spirometry parameters (M±m) between the patients of the main groups and control group at the end of the rehabilitation

Indicator, units of measurement		48 weeks
		MG₁ (n = 45)	MG₂ (n = 40)	MG₃ (n = 30)	CG (n = 50)
Vital capacity, l	Actual	2.95±0.04^*	2.73±0.03	2.97±0.05°	2.79±0.07
	% of predicted	95.86±1.58^**	88.30±1.60	94.50±2.04°	88.26±2.30
Forced vital capacity, l	Actual	2.81±0.03^***	2.64±0.02	2.70±0.04	2.61±0.05
	% of predicted	96.62±1.38^***	90.50±1.42	91.16±1.41	87.36±1.69
Forced expiratory volume in 1 second, l	Actual	2.62±0.02^***	2.38±0.04	2.43±0.04°	2.29±0.06
	% of predicted	109.75±1.77^***	98.67±2.17	99.40±1.82°	92.22±2.64
Peak expiratory flow, l/sec	Actual	4.82±0.13^**	3.79±0.13	3.95±0.08	4.18±0.19
	% of predicted	83.88±2.21^**	65.72±2.30	67.86±1.49	71.36±3.28
Maximum expiratory flow₂₅, l/sec	Actual	4.44±0.10^**	3.51±0.12	3.56±0.07	3.86±0.17
	% of predicted	88.06±2.12^***	69.17±2.54	69.56±1.66	74.26±3.43
Maximum expiratory flow₅₀, l/sec	Actual	3.97±0.07^**	3.38±0.11	3.70±0.07	3.47±0.16
	% of predicted	113.75±2.72^***	95.60±3.22	103.70±2.52	94.96±4.33
Inspiratory reserve volume, l		1.56±0.06^***	1.15±0.07	1.13±0.07	1.24±0.07
Expiratory reserve volume, l		0.97±0.06	1.01±0.10	1.02±0.10	1.18±0.09
Maximal voluntary ventilation, l/min		86.38±3.00	68.46±1.96^•^•	85.13±2.68	81.59±3.94

Notes: ^*p < 0,05; ^**p < 0,01; ^***p < 0,001 compared with the data of the first main group and control group; ^•^•p < 0,01 compared with the data of the second main group and control group; °p < 0,05 compared with the data of the third main group and control group; VC – Vital capacity, FVC – Forced vital capacity, FEV₁ – Forced expiratory volume in one second, PEF – Peak expiratory flow, MEF₂₅ – Maximum expiratory flow at 25% of FVC, MEF₅₀ – Maximal expiratory flow at 50% FVC, IRV – Inspiratory reserve volume, ERV – Expiratory reserve volume, MVV – Maximal voluntary ventilation.

Comparison results of spirometry parameters between the patients of the main groups during rehabilitation is given in Table 4. It was found that after year performing individualized physical rehabilitation programs (Table 4) the actual value of Forced vital capacity was statistically higher in women of the first main group compared with the second main group and third main group by 0.17 l (p < 0.001) and 0.11 l (p < 0.05), respectively; the actual value of the Forced expiratory volume in 1 second was better by 0.24 l (p < 0.001) and 0.19 l (p < 0.001), respectively; the actual value of Peak expiratory flow was better by 1.03 l/sec (p < 0.001) and 0.87 l/sec (p < 0.001), respectively; the actual value of Maximum expiratory flow₂₅ was higher by 0.93 l/sec (p < 0.001) and 0.88 l/sec (p < 0.001), respectively; the actual value of Maximum expiratory flow₅₀ was higher by 0.59 l/sec (p < 0.001) and 0.27 l/sec (p < 0.05), respectively; the actual value of Inspiratory reserve volume was higher by 0.41 l (p < 0.001) and 0.43 l (p < 0.001), respectively.

Comparison of spirometry parameters (Table 5) between the patients of the main groups and control group at the end of the rehabilitation showed that most of the respiratory indicators of women in the first main group were significantly higher than in healthy women of the control group.

The actual value of Vital capacity was statistically higher in women of the first main group compared with the control group by 0.16 l (p < 0.05); the actual value of Forced vital capacity was better by 0.20 l (p < 0.001); the actual value of the Forced expiratory volume in 1 second was better by 0.33 l (p < 0.001); the actual value of Peak expiratory flow was better by 0.64 l/sec (p < 0.01); the actual value of Maximum expiratory flow₂₅ was higher by 0.58 l/sec (p < 0.01); the actual value of Maximum expiratory flow₅₀ was higher by 0.50 l/sec (p < 0.01); the average value of Inspiratory reserve volume was statistically higher by 0.32 l (p < 0.001) at the end of the rehabilitation course.

Patients of the third main group had an advantage in comparison with the control group only in terms of the actual value of Vital capacity and Forced expiratory volume in 1 second that were higher by 0.18 l (p < 0.05) and 0.14 l (p < 0.05), respectively. However, the average values of Maximal voluntary ventilation were significantly lower by 13.13 l/min (p < 0.01) in the second main group as compared with the healthy women.

4 Discussion

Results from this research indicate that designing individualised physical rehabilitation programs had a positive effect on pulmonary function in women with post-mastectomy of all groups.

A considerable body of research demonstrate that physical exercises may be an effective method of attenuating the side effects of breast cancer therapies on cardiovascular system, fatigue, and cancer-related lymphedema [3 , 12–16]. Supervised, combined aerobic-resistance exercise shows positive results of reducing fatigue for breast cancer patients [19].

Some studies have examined cardiopulmonary parameters and aerobic exercise training in breast cancer survivors [12]. Differences in exercise training methods and outcome variables make it somewhat difficult direct comparisons between the studies in question the current experiment. Previous studies suggested aerobic training frequencies of 2-3 sessions per week, different durations and intensities [14, 15].

The current study applied the low-impact and middle-impact aerobic exercises according to the individual participants’ health status in pool and gym. Exercise intensity for women ranged from 40% to 60% of heart rate reserve. The strengths of our study were that the individualization of load intensity depended on the level of the functional state of cardiovascular system, which was determined by the author’s formula. It allows objectively assess the functional state of the cardiovascular system of women with post-mastectomy syndrome and plan a rehabilitation program.

The individualised physical rehabilitation programs resulted in increased vital capacity, forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, inspiratory reserve volume, expiratory reserve volume, and maximal voluntary ventilation in patients of all groups. This made it possible for women with post-mastectomy syndrome to approximate their respiratory function to the indicators of healthy women.

Prospects for further research would be aimed at determining the effectiveness of the individualised physical rehabilitation programs to improve the arm function and quality of life in women with post-mastectomy syndrome.

Conflict of interest

None declared.

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